Impact of the COVID-19 pandemic and control measures on type 2 diabetes care among South Asians: the perspective of healthcare providers in British Columbia, Canada.

BACKGROUND: British Columbia is one of the most ethnically diverse provinces in Canada, with South Asians emerging as one of the fastest-growing ethnic minority groups, burdened by a high incidence of type 2 diabetes. During the COVID-19 pandemic, many healthcare services shifted to virtual care to minimize infection transmission. Given the limited understanding of how primary care physicians in BC adapted their diabetes care approaches and the consequent impact on patient experience, this qualitative study aims to explore the effects of pandemic-related control measures on primary care diabetes services in BC from the perspectives of general practitioners, focusing particularly on their South Asian patients.

METHODS: We conducted semi-structured interviews with ten primary care physicians serving large South Asian patient populations. Interviews explored the pandemic's effects on care delivery, provider adaptations, and consequences for South Asian patients with diabetes. Sessions were held in person or via Zoom/Teams and transcribed verbatim. Transcripts underwent thematic content analysis to identify recurring themes and insights regarding barriers, adaptations, and recommendations to improve diabetes care.

FINDINGS: The COVID-19 pandemic disrupted diabetes care, shifting services to virtual care and interrupting routine monitoring. This transition impacted specific aspect of diabetes care that can best be provided in-person (e.g., foot examinations, blood pressure checks and lifestyle counselling). The pandemic compounded existing issues, e.g., cost, concerns with side effects, and medication compliance among South Asian patients. Physicians also observed a general rise in anxiety and depression during the pandemic among their patients. Older South Asian patients faced additional cultural, language, and digital barriers; physicians struggled to obtain timely Hemoglobin A1c (HbA1c) tests. For many patients, a significant reliance on pharmacists embedded within certain physician's clinics, ensured an uninterrupted access to diabetes medication and supplies.

CONCLUSION: The COVID-19 pandemic disrupted diabetes care, with some groups facing additional cultural, language, and digital barriers. Our findings highlight the need for primary care reforms: improved telemedicine and EMR infrastructure, and policies to support virtual care. Bridging the digital divide and implementing targeted supports are essential to minimize care disruption for vulnerable populations during future pandemics or similar crises and ensure equity.